Rapid Strep Test not used at the clinic I work at - problem?

[Just Steve]

the issue is that a lot of bad things happen in the throat besides strep. peritonsilar abscesses, etc and when you just check a strep and tx or not you disregard all other pathology.

 

i agree completely...I wasn't very clear in my point...Perhaps my nativity is shining through but I think I would prefer to trust the judgement of a critically thinking clinician over the single vs double line of a swab.

[EMEDPA]

i agree completely...I wasn't very clear in my point...Perhaps my nativity is shining through but I think I would prefer to trust the judgement of a critically thinking clinician over the single vs double line of a swab.

yup. lots of badness happens with a neg strep....epiglotitis, peritonsilar abscess, thyroiditis, retropharyngeal abscess, mono, lemierre's syndrome, oral ca, etc

[EMEDPA]

i agree completely...I wasn't very clear in my point...Perhaps my nativity is shining through but I think I would prefer to trust the judgement of a critically thinking clinician over the single vs double line of a swab.

yup. lots of badness happens with a neg strep....epiglotitis, peritonsilar abscess, thyroiditis, retropharyngeal abscess, mono, lemierre's syndrome, oral ca, etc

[Hemegroup]

be careful of coding ... my SP told me you won't get reimbursed by (forgot name of the certain) insurance if you prescribe abx for 'pharyngitis' without a rapid test being done. So if I prescribed based on criteria vs. rapid test, I just code for throat pain and skin infection.

[Hemegroup]

be careful of coding ... my SP told me you won't get reimbursed by (forgot name of the certain) insurance if you prescribe abx for 'pharyngitis' without a rapid test being done. So if I prescribed based on criteria vs. rapid test, I just code for throat pain and skin infection.

[Guest Paula]

Medicaid sends us notes at the end of the year telling us to not treat swab negative strep with Abx. Sends us out criteria of when or when not to use Abx, including otitis media, bronchitis, etc. Following centor if fine. It can work and ultimately it should be clinical judgement after a GOOD exam and thinking about all the differential. A sore throat is not always a sore throat.

 

One incident that irked me to no end was a colleague working with me at an urgent care center who would diagnose every single patient with the chief complaint the MA wrote down. One incident (of many and certainly not the worst) was a young 20 something woman who came in with CC of pussy eyes. The provider looked at her eyes, wrote a script for ABX eye drops, sent her on her way. Next day I am on, same patient back, I did full exam and she had strep positive swab and pussy eyes. Her complaint to me was the other provider did not look in throat, ears, check for nodes, listen to heart or lungs. She had complained of a sore throat, too.

 

So to all PAs out there....do the exam...don't take short cuts...ever....even when under stress....keep your standards high...never assume.

[Guest Paula]

Medicaid sends us notes at the end of the year telling us to not treat swab negative strep with Abx. Sends us out criteria of when or when not to use Abx, including otitis media, bronchitis, etc. Following centor if fine. It can work and ultimately it should be clinical judgement after a GOOD exam and thinking about all the differential. A sore throat is not always a sore throat.

 

One incident that irked me to no end was a colleague working with me at an urgent care center who would diagnose every single patient with the chief complaint the MA wrote down. One incident (of many and certainly not the worst) was a young 20 something woman who came in with CC of pussy eyes. The provider looked at her eyes, wrote a script for ABX eye drops, sent her on her way. Next day I am on, same patient back, I did full exam and she had strep positive swab and pussy eyes. Her complaint to me was the other provider did not look in throat, ears, check for nodes, listen to heart or lungs. She had complained of a sore throat, too.

 

So to all PAs out there....do the exam...don't take short cuts...ever....even when under stress....keep your standards high...never assume.

[EMEDPA]

and use the word purulent.....:)

[EMEDPA]

and use the word purulent.....:)

[Joelseff]

and use the word purulent.....:)

 

Hahaha....yes please....

 

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[Joelseff]

and use the word purulent.....:)

 

Hahaha....yes please....

 

Sent from my myTouch_4G_Slide using Tapatalk

[cupojava]

No monospot test either at one of the FP/UC places I work at (per MD's preference).

 

I am just wondering I should be pushing to get the rapid strep test (and monospot) at the clinic, cause I find myself Rx'ing more antibiotics for pharyngitis. I know that rheumatic fever is pretty rare in the US, but I don't know know if it's because we are over-Rxing antibiotics or another reason. What does this mean in terms of liability? Does this mean I can rely on the CENTOR criteria without any need for any sort of assay?

If your clinic does not have in-house lab, can't you just send them to get "Rapid strep test with default to culture if negative RST" at the local hospital lab? As long as the patient appears non-toxic, you can have the pt wait for lab confirmation. Link below is the latest guidelines from IDSA.http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/grpastrepidsa.pdf

[cupojava]

No monospot test either at one of the FP/UC places I work at (per MD's preference).

 

I am just wondering I should be pushing to get the rapid strep test (and monospot) at the clinic, cause I find myself Rx'ing more antibiotics for pharyngitis. I know that rheumatic fever is pretty rare in the US, but I don't know know if it's because we are over-Rxing antibiotics or another reason. What does this mean in terms of liability? Does this mean I can rely on the CENTOR criteria without any need for any sort of assay?

If your clinic does not have in-house lab, can't you just send them to get "Rapid strep test with default to culture if negative RST" at the local hospital lab? As long as the patient appears non-toxic, you can have the pt wait for lab confirmation. Link below is the latest guidelines from IDSA.http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/grpastrepidsa.pdf

[ventana]

HAAAHAAA

 

one of the learning curves of PAs everywhere

 

puss and puss#

 

course now everyone just blames it on spell check......

[ventana]

HAAAHAAA

 

one of the learning curves of PAs everywhere

 

puss and puss#

 

course now everyone just blames it on spell check......

[Guest Paula]

and use the word purulent.....:)

 

Haha. yeah, I know. lapse of terminology. I call it dyslexia of the keypad!

[Guest Paula]

and use the word purulent.....:)

 

Haha. yeah, I know. lapse of terminology. I call it dyslexia of the keypad!

[rcdavis]

Somewhere 6-7 years ago is the infamous back and forth between LaughingAngel and me about the P word: noun, adjective, verb, or adverb? Or all?

 

She hate(s)(d) that word.. And The discussion became at times intense... And we became good friends because of it.. Which of course adds "conjunction" to its descriptors. Ahh.... the ubiquitous pus$y....

[rcdavis]

Somewhere 6-7 years ago is the infamous back and forth between LaughingAngel and me about the P word: noun, adjective, verb, or adverb? Or all?

 

She hate(s)(d) that word.. And The discussion became at times intense... And we became good friends because of it.. Which of course adds "conjunction" to its descriptors. Ahh.... the ubiquitous pus$y....

[Hemegroup]

Medicaid sends us notes at the end of the year telling us to not treat swab negative strep with Abx. Sends us out criteria of when or when not to use Abx, including otitis media, bronchitis, etc. Following centor if fine. It can work and ultimately it should be clinical judgement after a GOOD exam and thinking about all the differential. A sore throat is not always a sore throat.

 

One incident that irked me to no end was a colleague working with me at an urgent care center who would diagnose every single patient with the chief complaint the MA wrote down. One incident (of many and certainly not the worst) was a young 20 something woman who came in with CC of pussy eyes. The provider looked at her eyes, wrote a script for ABX eye drops, sent her on her way. Next day I am on, same patient back, I did full exam and she had strep positive swab and pussy eyes. Her complaint to me was the other provider did not look in throat, ears, check for nodes, listen to heart or lungs. She had complained of a sore throat, too.

 

So to all PAs out there....do the exam...don't take short cuts...ever....even when under stress....keep your standards high...never assume.

 

I can't count the number of kids I get who were sent from the ER or Urgent Care with a 'gastroenteritis' diagnosis only to find a raging OM causing the whole deal. Did they look in the ears? Of course not.

[Teasip]

^^^ that! GI sx in a pre-schooler/elementary student, always look at the head.

[ToBeWhole]

and use the word purulent.....:)

 

please please please!! :)

 

 

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[ToBeWhole]

So to all PAs out there....do the exam...don't take short cuts...ever....even when under stress....keep your standards high...never assume.

 

great advice, Paula.

 

 

 

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